Legislative News

What Kind of Change Will Come?

William A. Hazel Jr., MD
Member, Board of Trustees
American Medical Association

Following the inauguration of Barack Obama as President, it is appropriate to consider what this means to us as physicians and orthopaedic surgeons. What is this “change” that has been hoped for and promised? How will it effect us? What should we be doing to prepare ourselves?

The early evidence is that the new administration will be somewhat pragmatic. The cabinet and key positions are filled with known quantities who have vast Washington experience. It appears that President Obama is truly looking to create policy based on a broad consensus. He will have to, if he is to achieve his goals especially with respect to health care. The economy and the Medicare and Social Security entitlement issues that threaten to overwhelm our country will also play a role in what is politically possible.

President Obama has established a team that has a definite interest in reforming our health care system. In particular, there is a desire to ensure that virtually all Americans have health insurance. Although President Obama has called for a government insurance program to compete against private insurers, there will be much resistance to this idea. Many in the Congressional leadership believe that a single payer system is needed. There is significant opposition to this idea as well. More likely we will see a system modeled after the Massachusetts experience or an expansion of the Federal Employee Health Benefit Program. Either way, we as physicians will continue to face calls for better quality and safety and evidence of cost effectiveness.

The single national issue that most effects our practices is Medicare payment. By the end of 2009, Congress must act to prevent a 20% cut in Medicare payments to physicians. Our AMA has argued that the SGR formula that dictates these cuts must be done away with and replaced with a methodology that provides for stable and predictable payments that cover the cost of providing care to our seniors. Congress, by the 18 month reprieve voted in July, has signaled that it understands the problem. Their challenge will be to find the money in the budget to pay for the increases. So long as physicians participate in Medicare, there will be the temptation to see how low they can drop the payments.

In return for changing the payment formula, Congress is likely to increase its demands on physicians. There is widespread belief that Health IT will promote better care and cost savings. We already have the potential for a “bonus” for e-prescribing. In 2 years, there will be a penalty for not doing so. The call for EHR’s is likely to accelerate and funding of health IT is part of the deficit reduction package that recently passed the House. We must be prepared to implement these tools in the near future and should become familiar with implementation issues as soon as possible.

Another area in which Congress has challenged us is quality reporting in the form of the PQRI (Physicians Quality Reporting Initiative). We currently have the opportunity to be paid for quality reporting. The AAOS has a web page devoted to understanding this system. It is important to understand what is being asked of us and why. “Conventional wisdom” now is that there is tremendous practice variability across the country and that we are not optimizing quality and safety. We may reject these claims and still be faced with proving our position. Surgeons must understand (if not agree) with the public and political perception and recognize that each of us needs to do our part to address these concerns.

The PQRI is in its second year. While we may question its premise and its value, it is more likely that we will see bigger and expanded versions of this program in the future not only in Medicare but also in private programs.  It is going to be increasingly important to us to be able to document our practice patterns and outcomes, and we should consider being proactive in this area in order to counter burdensome regulatory approaches.

Liability issues remain a major concern but it is unlikely that this Congress and administration will be politically able to reform the tort system. This will remain a state issue primarily. Be aware that our liability cap in Virginia is under attack this year, and the Medical Society of Virginia will need our support in membership and funds to fight for our cause.

The AMA will continue to aggressively advocate for physicians. Our challenge will be to stay united as a profession especially as we deal with physician payment issues. There are approximately one million physicians in the USA. About 75% of us actively practice today. One million in a population of 260 million is not a big number. When given the opportunity to choose sides between physician groups, Congress will cater to the voters and choose to get re-elected. In other words, we lose.

Our opportunity is to regain the trust of our patients and by providing what they are demanding, shift the balance of power from insurers, hospitals, and regulators to physicians. Our patients are looking for coordination of care, safe and effective care, convenience, and some way to afford the care we provide. For us to have the practices that we want, we must ensure that our colleagues who want to do the care coordination survive financially to provide those services. We must also invest in the systems and technology in order to improve our service and our political position.


Advocacy Update

Here are a few of the policy and budget highlights from the recent 2009 General Assembly session:

Medical Malpractice Cap
Senator Henry Marsh (D-Richmond) introduced a bill that would have raised Virginia’s medical malpractice cap to $2.5 million dollars and attached an inflation factor.  In exchange for striking his bill, Marsh has demanded that stakeholders meet during 2009 off-session to come up with a plan for future increases.  The physician community supports the current cap and has educated the legislators about the cap’s stabilizing effect on med/mal insurance markets.

Certificate of Public Need Reform
HB 1598 (Hamilton, R-Newport News) reduces the application criteria considered by the Virginia Department of Health (VDH) Commissioner and puts increased emphasis on competition, access to services, and quality.  It also removes the regional health planning agencies from the decision-making process and allows for electronic filing of applications.

Naturopathic Physician Bill Defeated
The House Health Welfare & Institutions Subcommittee on Health, chaired by Delegate John O'Bannon, MD (R-Henrico), unanimously killed HB 1820 (Kilgore, R-Gate City) after a lengthy debate and testimony from proponents and opponents.  HB 1820 would have licensed naturopaths and created an advisory board under the Board of Medicine.  The Medical Society of Virginia and specialty societies were concerned about the broad scope of practice the legislation gave to naturopaths and public confusion about what they would be qualified to do.

VOS Legislator of the Year
Delegate Phillip Hamilton

The VOS Board of Directors has recognized Delegate Phillip Hamilton (R-Newport News) as the 2008 “Legislator of the Year”.   He is Chairman of the House Health Welfare & Institutions (HWI) committee and Chairman of the Appropriations Subcommittee on Health & Human Resources.  Delegate Hamilton will be honored at the VOS Annual Meeting at the Hilton Virginia Beach during a reception on Friday, May 1 at 6:00 pm.

Please contact VOS lobbyist Cal Whitehead at with questions about the Society’s advocacy efforts.



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